"Cuffitis" and inflammatory changes in the columnar cuff, anal transitional zone, and ileal reservoir after stapled pouch-anal anastomosis

PURPOSE: During the past eight to ten years most surgeons have adopted the double-stapled technique to accomplish the pouch-anal anastomosis in restor ative proctocolectomy for ulcerative colitis. Little attention has been foc used on the functional implications of retaining a segment of diseased colu mnar mucosa in the upper anal canal. The aim of this study was to investiga te clinically significant inflammation in the columnar cuff. METHOD: In all , 113 patients were studied and 715 biopsies were performed during a 2.5-ye ar period. Biopsy specimens were taken from two or three sites, including t he columnar cuff, ileal pouch, and anal transitional zone. Acute and chroni c inflammation was scored for biopsy specimens from all three sites and com pared with endoscopic assessment and pouch function. RESULTS: In the colum nar cuff acute histologic inflammation was found in 13 percent of patients, and in 9 percent this was symptomatic during followup and was accompanied by evidence of endoscopic inflammation. Most patients dad mild inflammation in the cuff that persisted over time. Inflammation in the pouch, pouch fre quency, and anastomotic height were not related to columnar cuff inflammati on. CONCLUSIONS: Cuffitis is a cause of pouch dysfunction after a double-st apled restorative proctocolectomy. We propose a triad of diagnostic criteri a, including symptoms and endoscopic and histologic inflammation.